Details

Autor(en) / Beteiligte

• Lanaret, Camille
• Anglicheau, Dany
• Audard, Vincent
• Büchler, Mathias
• Caillard, Sophie
• Couzi, Lionel
• Malvezzi, Paolo
• Mesnard, Laurent
• Bertrand, Dominique
• Martinez, Franck
• Pernin, Vincent
• Ducloux, Didier
• Poulain, Coralie
• Thierry, Antoine
• Del Bello, Arnaud
• Rerolle, Jean P.
• Greze, Clarisse
• Uro‐Coste, Charlotte
• Aniort, Julien
• Lambert, Céline
• Bouvier, Nicolas
• Schvartz, Betoul
• Maillard, Nicolas
• Sayegh, Johnny
• Oniszczuk, Julie
• Morin, Marie‐Pascale
• Legendre, Christophe
• Kamar, Nassim
• Heng, Anne E.
• Garrouste, Cyril

Titel

Rituximab for recurrence of primary focal segmental glomerulosclerosis after kidney transplantation: Results of a nationwide study

Ist Teil von

• American journal of transplantation, 2021-09, Vol.21 (9), p.3021-3033

Ort / Verlag

United States: Wiley Subscription Services, Inc

Erscheinungsjahr

2021

Quelle

MEDLINE

Beschreibungen/Notizen

• Rituximab (RTX) therapy for primary focal segmental glomerulosclerosis recurrence after kidney transplantation (KT) has been extensively debated. We aimed to assess the benefit of adding RTX to plasmapheresis (PP), corticosteroids, and calcineurin inhibitors (standard of care, SOC). We identified 148 adult patients who received KT in 12/2004–12/2018 at 21 French centers: 109 received SOC (Group 1, G1), and 39 received immediate RTX along with SOC (Group 2, G2). In G1, RTX was introduced after 28 days of SOC in the event of failure (G1a, n = 19) or PP withdrawal (G1b, n = 12). Complete remission (CR) was achieved in 46.6% of patients, and partial remission (PR) was achieved in 33.1%. The 10‐year graft survival rates were 64.7% and 17.9% in responders and nonresponders, respectively. Propensity score analysis showed no difference in CR+PR rates between G1 (82.6%) and G2 (71.8%) (p = .08). Following the addition of RTX (G1a), 26.3% of patients had CR, and 31.6% had PR. The incidence of severe infections was similar between patients treated with and without RTX. In multivariable analysis, infection episodes were associated with hypogammaglobulinemia <5 g/L. RTX could be used in cases of SOC failure or remission for early discontinuation of PP without increasing the risk of infection. This French nationwide retrospective study shows that rituximab may be useful to treat recurrent focal segmental glomerulosclerosis in adult kidney transplant recipients after conventional treatment failure or to facilitate plasmapheresis discontinuation more rapidly after achieving remission.